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Key Facts: CDEI Exam

150

Total Items

AAPC

4 hrs

Exam Time

AAPC

70%

Passing Score

AAPC

31

PCS Root Operations

Medical/Surgical section

The AAPC CDEI (Certified Documentation Expert Inpatient) consists of 150 MCQ items over 4 hours with 70% passing. Master ICD-10-CM PDX selection, ICD-10-PCS root operations, MS-DRG/APR-DRG, CC/MCC capture, and AHIMA/ACDIS query best practices.

Sample CDEI Practice Questions

Try these sample questions to review concepts for the CDEI exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Per UHDDS guidelines, the principal diagnosis is defined as the condition established after study to be chiefly responsible for what?
A.The patient's chief complaint at presentation
B.The admission of the patient to the hospital
C.The highest reimbursement under MS-DRG
D.The most resource-intensive condition during the stay
Explanation: UHDDS defines the principal diagnosis as the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.
2A patient is admitted with pneumonia and develops a urinary tract infection on day three of the inpatient stay. What is the correct POA indicator for the UTI?
A.Y
B.N
C.U
D.W
Explanation: POA indicator 'N' is assigned when a condition is not present at the time of inpatient admission, such as a UTI that develops on hospital day three.
3Which ICD-10-CM code reports severe sepsis without septic shock?
A.A41.9
B.R65.20
C.R65.21
D.R65.10
Explanation: R65.20 reports severe sepsis without septic shock and requires an underlying systemic infection code plus a code for the associated acute organ dysfunction.
4A patient is admitted with sepsis due to E. coli that progresses to septic shock with acute kidney injury. Which combination correctly captures the severe sepsis with shock?
A.A41.51 + R65.20 + N17.9
B.A41.51 + R65.21 + N17.9
C.A41.9 + R65.20 + N17.9
D.A41.51 + R65.21 only
Explanation: Severe sepsis with septic shock requires the underlying infection code (A41.51), R65.21 for severe sepsis with septic shock, and a code for the acute organ dysfunction (N17.9 AKI).
5Which code reports acute kidney failure, unspecified?
A.N17.0
B.N17.8
C.N17.9
D.N18.9
Explanation: N17.9 is acute kidney failure, unspecified, used when the type of acute renal failure is not further specified.
6A patient with documented witnessed aspiration of gastric contents is later treated for resulting pneumonia. Which ICD-10-CM code captures aspiration pneumonia?
A.J18.9
B.J69.0
C.J15.9
D.J69.1
Explanation: J69.0 reports pneumonitis due to inhalation of food and vomit, which is the correct code for aspiration pneumonia from gastric contents.
7Which ICD-10-CM code reports metabolic encephalopathy?
A.G93.40
B.G93.41
C.G93.49
D.G92.9
Explanation: G93.49 reports other encephalopathy and is assigned for metabolic encephalopathy when documented by the provider.
8A patient is admitted with acute systolic congestive heart failure. Which ICD-10-CM code is reported?
A.I50.21
B.I50.22
C.I50.23
D.I50.20
Explanation: I50.21 reports acute systolic (congestive) heart failure.
9Which code reports acute on chronic combined systolic and diastolic heart failure?
A.I50.41
B.I50.42
C.I50.43
D.I50.81
Explanation: I50.43 reports acute on chronic combined systolic (congestive) and diastolic (heart failure).
10Which ICD-10-CM code reports a STEMI of the anterior wall involving the left anterior descending coronary artery?
A.I21.01
B.I21.02
C.I21.09
D.I21.4
Explanation: I21.01 reports ST elevation myocardial infarction involving left main coronary artery; the LAD is reported with I21.02. Best fit per code description for anterior wall STEMI involving LAD is I21.02; however when LAD is documented, I21.02 applies.

About the CDEI Exam

AAPC credential for inpatient Clinical Documentation Improvement (CDI) specialists. Validates expertise in ICD-10-CM principal diagnosis selection (UHDDS), ICD-10-PCS procedure coding (7-character structure, 31 root operations), MS-DRG and APR-DRG assignment, CC/MCC capture and severity of illness, AHIMA/ACDIS-compliant provider queries, and inpatient compliance/audit risks (HACs, two-midnight rule, OIG focus areas).

Exam sponsor: AAPC. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

150 questions

Time Limit

4 hours

Passing Score

70%

Exam / Certification Fees

Per AAPC

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25%

ICD-10-CM Inpatient Diagnosis Coding

PDX selection (UHDDS), POA indicators, sepsis, AKI, encephalopathy, heart failure, MI, CKD

20%

ICD-10-PCS Procedure Coding

7-character structure, 31 root operations, Excision vs Resection vs Destruction, Bypass vs Reposition

15%

MS-DRG / APR-DRG Assignment

MDC selection, base DRG, CC/MCC modifiers, relative weight, CMI, APR-DRG SOI/ROM

15%

CC/MCC Capture and Severity of Illness

Sepsis MCC, AKI CC, encephalopathy MCC, severe PCM MCC, clinical indicators

10%

CDI Process and Provider Query

AHIMA/ACDIS practice brief, non-leading queries, concurrent vs retrospective

15%

Compliance and Audit

OIG audit work plan, MAC/RAC reviews, two-midnight rule, HACs, HRRP penalties, SEP-1

Preparing for the CDEI Exam

What You Need to Know

  • Passing score: 70%
  • Exam length: 150 questions
  • Time limit: 4 hours
  • Exam / certification fees: Per AAPC Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

CDEI: Suggested Study Strategy

1Master ICD-10-CM PDX selection per UHDDS: 'condition established after study chiefly responsible for occasioning admission'
2Know the 31 ICD-10-PCS Medical/Surgical root operations: Alteration, Bypass, Change, Control, Creation, Destruction, Detachment, Dilation, Division, Drainage, Excision, Extirpation, Extraction, Fragmentation, Fusion, Insertion, Inspection, Map, Occlusion, Reattachment, Release, Removal, Repair, Replacement, Reposition, Resection, Restriction, Revision, Supplement, Transfer, Transplantation
3Understand POA (Present on Admission) indicators: Y/N/U/W. Y exempts certain HACs; N triggers HAC payment penalty for non-payment-eligible conditions
4Know HACs that trigger non-payment: stage 3/4 pressure injury, falls/trauma, CAUTI, CLABSI, certain SSIs, foreign body retained after surgery, blood incompatibility, air embolism

Frequently Asked Questions

What's the difference between CDEI and CDEO?

CDEI is for INPATIENT CDI — hospital admissions, ICD-10-CM PDX, ICD-10-PCS procedures, MS-DRG and APR-DRG assignment. CDEO is for OUTPATIENT CDI — physician office, hospital outpatient, ASC, with HCC risk adjustment focus. Both are AAPC credentials.

What ICD-10-PCS knowledge is essential?

Master the 7-character structure (section, body system, root operation, body part, approach, device, qualifier) and the 31 root operations in Medical and Surgical, especially distinguishing Excision (portion) vs Resection (entire body part), Bypass vs Reposition, Replacement vs Insertion. Common procedures: CABG, hysterectomy, knee replacement, mechanical ventilation.

What is the difference between MS-DRG and APR-DRG?

MS-DRG (Medicare Severity DRG) drives Medicare inpatient payment: principal Dx → MDC → base DRG → CC/MCC modifies → final DRG. APR-DRG (All Patient Refined DRG) is used by Medicaid and quality measurement; it has 4 levels of Severity of Illness (SOI) and 4 levels of Risk of Mortality (ROM) driven by all secondary diagnoses.